Statement to furnish information on transaction of crypt-asset under section 509

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.... A.1.12 (a) TIN (refer Note 4) (b) TIN issuing country (drop down) (c) Reason for non-availability of TIN (select anyone) • N - Because one was not issued by the reportable jurisdiction. • D - Because the domestic law of the reportable jurisdiction does not require the collection of the TIN. A.1.13 (a) Any other identification/registration number (only to be provided where RCASP is an entity) (refer Note 5) (b) Identification issuing country (drop down) (c) Identification type • LEI - legal entity identifier; • EIN - entity identification number; • BRN - business registration number; • OTH - any other Type of identification such as Company Identification Number, US GIIN, Passport, Voter ID, Driving Licence, Social Security Number etc. (d) If answer to (c) above is "OTH", please provide identification type   A.1.14 Reporting obligation nexus • 901 - Tax Resident of India • 902 - Incorporation under the laws of India • 903 - Management in India • 904 - Place of Business in India • 905 - ....

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.... • N: New User • P: Pre-existing User B.2.2 Unique user id allotted by RCASP   B.2.3 Name (refer Note 1) B.2.4 Father's name (refer Note 1) B.2.5 Gender • M - Male • F - Female • O - Others B.2.6 (a) TIN (refer Note 4) (b) TIN issuing country (drop down) (c) Reason for non-availability of TIN • N - Because one was not issued by the reportable jurisdiction. • D - Because the domestic law of the reportable jurisdiction does not require the collection of the TIN. B.2.7 Permanent Account Number, if available   B.2.8 Aadhaar number, if available   B.2.9 (a) Occupation type • S - Salaried • B - Business • ST - Student • N - Not Occupied • D - Dependent • O - Others (b) If answer to (a) above is "O", please provide occupation type   B.2.10 Country of residence as per tax laws (drop down) B.2.11 (a) Address (refer Note 2) (b) Legal character of the address (select anyone) • 301- Residential....

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....) (b) Legal character of the address (select anyone) • 301- Residential Or Business • 302 - Residential • 303 - Business • 304 - Registered Office • 305 - Unspecified   (repeat details in row B.3.8 and B.3.9, if crypto-asset user is tax resident of more than one country or territory outside India) B.3.10 Date of incorporation YYYY-MM-DD B.3.11 Place of incorporation (refer Note 10) B.3.12 Mobile number   B.3.13 Telephone number   B.3.14 Email   B.3.15 Self-certification • Y: Yes • N: No B.4 Controlling person details (to be provided for each controlling person of the entities) B.4.1 Controlling person type • 801 - Controlling Person of legal person - ownership • 802 - Controlling Person of legal person - other means • 803 - Controlling Person of legal person - senior managing official • 804 - Controlling Person of legal arrangement - trust - settlor • 805 - Controlling Person of legal arrangement - trust - trustee • 806 - ....

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....: Transaction Details (This information should be provided for each relevant transaction of each relevant crypto-asset) C.1 Crypto asset details C.1.1 Name of crypto asset (refer Note 11) Digital token identifier Insert 9 character code Other token (to be provided if digital token identifier is not known)   C.2 Relevant transaction details   C.2.1 Crypto to crypto in   C.2.1.1 Exchange type (select anyone) • 401 - Staking • 402 - Crypto Loan • 403 - Wrapping • 404 - Collateral C.2.1.2 Number of transactions (refer Note 12) C.2.1.3 Amount (in Indian Rupees)   C.2.1.4 Currency code (drop down) C.2.1.5 Number of units (refer Note 13) C.2.2 Crypto to crypto out   C.2.2.1 Exchange type (select anyone) • 401 - Staking • 402 - Crypto Loan • 403 - Wrapping • 404 - Collateral C.2.2.2 Number of transactions (refer Note 14) C.2.2.3 Amount (in Indian Rupees)   C.2.2.4 Currency code (drop down) C.2.2.5 Number of units ....

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....C.2.6.3 Amount (in Indian Rupees)   C.2.6.4 Currency code (drop down) C.2.6.5 Number of units (refer Note 23) C.2.6.6 Alternative valuation method (select anyone) • 1001 - Book value • 1002 - Third-party value • 1003 - Recent RCASP valuation • 1004 - Reasonable estimate by RCASP C.2.7 Transfer wallet   C.2.7.1 Amount (in Indian Rupees)   C.2.7.2 Currency code (drop down) C.2.7.3 Number of units (refer Note 24) C.2.7.4 Alternative valuation method (select anyone) • 1001 - Book value • 1002 - Third-party value • 1003 - Recent RCASP valuation • 1004 - Reasonable estimate by RCASP C.2.8 Reportable retail payment transactions   C.2.8.1 Number of transactions (refer Note 25) C.2.8.2 Amount (in Indian Rupees)   C.2.8.3 Currency code (drop down) C.2.8.4 Number of units (refer Note 26) Verification I.......... (name of designated director) having Permanent Account Number (PAN).........., in my capacity as designated director of........... (....

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....ed to exist) shall also be provided. 4. Tax identification number (TIN) used by the tax administration of the other country or territory of residence should be provided. In case no TIN is available, either the functional equivalent should be provided or the value "NOTIN" should be entered. 5. This field should be filled if the TIN field is marked as 'NOTIN'. This shall be filled with other Identification Numbers (INs) available. This should correspond to the Number mentioned in the identification document. 6. This field should be filled if RCASP has an equivalent or stronger nexus in another other country or territory, whereby reporting under the CARF will take place in such jurisdiction 7. (a) Statement number captures the sender's unique identifying number (created by the sender) that identifies the particular statement being sent. Example of the statement number is 2027/01. (b) After successful submission of the statement to ITD, a new unique Statement ID will be allotted for future reference. The reporting entities should maintain the linkage between the statement number and statement ID. 8. In case the original statement is being replaced by this statement, s....